Constipation

I'm not sure if this is practicing good medicine or not, but coworkers and I were sitting around the other night discussing the various alternatives to patient care (read: ways to avoid actually completing the order) when a doctor orders an enema on a young and otherwise healthy patient. Really, we'll do anything to get out an enema administration. They're not fun. Trust me.

In this conversation, I mentioned the best constipation remedy I've ever heard of - it was a comment from Hood Nurse, and I still laugh about it and wish I could tell my patients this:

If you are young, healthy, and just suffer from an unfortunate lack of fiber in your diet and subsequently think "should I go to the ER because I haven't pooped in four days?" then the answer is no. Go home, drink one cup of black coffee, eat one taco bell taco or burrito with hot sauce, and then go for a jog around the block. If you don't run the risk of shitting your pants before making it back to your house, then you may come to the ER and we will give you a bottle of mag citrate.

Pretty sure that's not an exact science though, so take it with a grain of salt. And don't sue me if it doesn't work, because this is the internet and contrary to popular opinion not everything on here is true.

Blame

There's this one doc I work with who is super slow at seeing patients and discharging them, but is otherwise a great provider. She's smart and thorough and a really nice person. The patients like her because she takes the time to explain everything to them, and is also very good about telling them exactly what to expect during their stay - things like "I'm worried you may have something wrong with your belly, so we're going to do bloodwork and I'll be ordering a CT with contrast. The contrast can't be given until your kidney function is confirmed as good, so it won't be done until your blood tests are back which will take around an hour. The CT will then probably take around 2 hours to be done and resulted, and since it's a busy day it will probably take me a little bit longer to get back in to you with the results. But Shrtstormtrooper here will keep me updated on how you're doing and if you're in too much pain, so make sure you communicate with her. Any questions? Can I get you a blanket?"

I mean, it took forever for me to just write that, let alone have her explain that to a patient. But I don't really mind the delay because communication really does (sometimes, if the patient is logical) prevent pissed-off people. Also, alliteration.

However, we use Meditech at this here hospital, and it's a piece of shit. This doc hates is so much that she frequently just bursts out in a string of curses whenever trying to do something mundane like chart or order something or review a test. Since she is not the quickest to begin with, this EMR just turns a slower pace into something exponentially more lumbering and painful.

So the other day, we had a patient who was somehow connected to the bigwigs at the hospital. He came in for a pretty minor reason, but the department was slamming busy and the primary nurse hadn't gotten back in after the initial assessment. The guy comes out to the nursing station, and sees this doc standing there. He's like "what's taking so long? I just got asked my address at least four times by two different people!"

Doc jumps on the opportunity that no one else is ballsy enough to take. She says "It's Meditech! It's a terrible, outdated system which doesn't allow anyone to communicate with each other and we have to ask the same questions a million times! I'm still trying to document from patients I had hours ago, and that's why I haven't been in to see you yet. You should definitely take this to the board and let them know that Meditech is awful and directly affects patient care. I'm not kidding..."

I am 99% sure the guy took it to heart, and I can only hope that somewhere, somehow, an HCA exec is getting ripped a new one for supporting such a terrible EMR.